Title: The Devil's In the DetailsRating: PGCharacters: House, Wilson, CuddySummary: The Devil's In the Details again centers around the House-Wilson-Cuddy bond. The story has a lot of introspection, especially for House and Wilson. The plot (such as it is....) centers around House's undiagnosed left leg pain.

And tonight's chapters, which should clear up the diagnosis of House's left leg pain:

CHAPTER TWENTY-FIVE: Betrayed

Wilson clicks on the voice file from last night’s conversation, and smiles sadly as he hears the first statement he’d made to Dick, because in any other circumstance Dick’s oversightmight never have been noticed:

‘When we were talking about how the loss of the breakthrough pain might affect House, you mentioned that there could be serious consequences if he didn’t acknowledge the change, and accept it. But, uh … I think maybe you might’ve forgotten to mention what those consequences might be. And I guess I need to know…. ’

Wilson’s smile fades quickly as he listens to Dickinson’s answer:

‘Well, the most serious thing, of course, would be a conversion disorder, or a psychosomatic illness.’

Wilson pauses the file and picks up the cover page from the test results. He’s read and reread the last few lines several times, but now he reads them again. And of course, the words haven’t changed:

POSSIBLE DIAGNOSES AND RECOMMENDATIONS: A full battery of tests, including imaging studies with and without contrast, bloodwork, nerve conduction studies, and an electromyogram, have revealed no underlying physiological disease process. No pathology was detected. In light of these results, recommendation is that malingering or psychosomatic illness be given consideration.

Wilson knows that malingering isn’t the problem; that leaves only one thing, something that shouldn’t be the problem. Something that wouldn’t be the problem if I’d talked to him. Damn.

He resumes the file and listens as he reads the same damning lines aloud to Dickinson, and as Dickinson asks him if he’s blaming himself.

‘Of course I’m blaming myself; who else is there? How many times did you tell me to speak with him about his changing self-perception? Hell, even Cuddy realized the importance of that after she listened to our session. I thought it wasn’t necessary, and now he’s paying for it.’

‘James, let it go. Let go of the guilt. It won’t help Dr. House, and it’ll paralyze you, and then you won’t be able to help him either. It should help you to know that, in my opinion, this would’ve happened anyway. You made several good points the last time we talked. You told me he wouldn’t be receptive to such a conversation, and you know him well, so I’ve no reason to doubt that. But the most important thing you told me was that the problems with his left leg started on his first full day home. So you were correct when you pointed out that he hadn’t had time to view his pain problems any differently.’

Wilson pauses the file again, and starts scribbling a timeline on the legal pad. When he’s finished, he reads it over thoughtfully. As he reads, a little of the weight is lifting from his shoulders; some of the guilt begins to recede. “Maybe he’s right about that,” he murmurs aloud. He resumes play.

‘Maybe, maybe not. I’ll deal with the guilt, Dick. That’s not why I’m calling you. The overriding concern is House. If this diagnosis is accurate—and I really can’t see any way around that—then how do I help him? And how do I even tell him?”

“You can’t tell him yet. First, you have to accept it. Otherwise, he’ll pick up on your guilt, your doubt, and he’ll grab onto those to deny the reality of the diagnosis.”

“No. I’m going to tell him. Right away. I can’t keep this from him; I won’t. I promised him my honesty. I’ve practically forced him to trust me. I owe him that; I owe him so much more than that, after what my own disbelief did to him for months. I won’t even consider hiding this from him. No.’

There’s a long pause at this point in the recording, and as Wilson listens to the silence, knowing what comes next, he can’t help wondering if Dick is going to be right.

‘You told me, the first time you came to see me, that you were willing to sacrifice the friendship if it meant saving the friend. You need to know that if you insist on telling him before he’s ready, before you’re ready, that you may, in fact, be making that sacrifice.’

‘That can’t matter. Any loss I take isn’t important, as long as House gets through this, and gets well. As long as his sense of trust isn’t disrupted again. He may blame me for this; he may even hate me. But at least he’ll know that I was honest with him, and I know House; no matter what happens, he’ll never forget that.’

Dick’s sigh is so loud that it transmits clearly on the recording, and when he resumes speaking, his voice is resigned—but it’s clear that, although he doesn’t agree with Wilson’s decision, he’s going to try to help him as best he can.

‘Then just tell him. Don’t sugarcoat it. And be prepared for his anger, and for his rejection of the diagnosis. And all you’ll be able to do is give him time, and give him room. The situation won’t resolve unless and until he accepts it. I don’t know how long that’ll take. The good news here is your stubborn insistence on total honesty; he may, eventually, give that high importance in reaching a decision to combat this. Don’t get me wrong; I still think telling him right now is a mistake, but I’m willing to say it could pay off, in the long run.’

‘Thanks, Dick; it’s good to know there’s some hope. I’ve got another question. I told you about the pneumonia earlier, during our regular call. Aside from that, he’s showing improvement overall. It’s slow, but it’s steady. Could any reaction he has to this new diagnosis endanger his recovery?’

‘No, I don’t think so. He’s got the most conscientious doctor on the planet; his general recovery should continue unimpeded. But now I have a question for you. I know you can handle getting him through this newest diagnosis. But you’re gonna need some guidance. The only way I can do that effectively is to meet him, try and get an idea of how—or if—he’s coping. Think he’s up to that poker game yet? Say, Friday night?’

‘That’s three days away; the pneumonia should be pretty close to resolved by then. Yeah, we could try it. Just… uh… don’t expect a warm reception from him, okay?’

‘Now there’s a surprise! Here I was, expecting to be treated like visiting royalty—the good china, and his best manners. Damn, I’m disappointed!’

Dick laughs at this point, and Wilson, listening now, allows himself a chuckle, and wonders if even Dick is any match for the barbed sarcasm that’s sure to come his way.

The next part of the discussion is especially difficult for Wilson to listen to, as Dick points out all the missed clues; House’s recurring nightmare, where Wilson actually accuses House of defining himself through his pain, and Wilson’s awful dream of watching House destroy his left thigh to spite Wilson’s belief that House needed to be in pain. And the timing of the spasms, almost always coming when House would be feeling insecure. Even the most recent “dream spasm,” which ended when House awakened, but turned into an actual spasm when House was contemplating the need for a muscle biopsy.

Wilson makes careful notes, listing all these incidents, and remembering others, like the night they’d returned from the nerve-wracking tests at Princeton General, and the morning House had begged Wilson not to leave for the day. He writes these down as well.

Wilson continues to listen to the file as Dickinson’s voice tells him that, ideally, the discussion about self-perception should have come prior to the treatment for breakthrough pain. It’s Dick’s theory that House hadn’t had the time to really assimilate the information that he was no longer being doubted by the people closest to him. He also hadn’t yet had confidence in his own decision to trust Wilson and Cuddy. As a result, Dick continues, his brain is now rebelling against both the rapid physical and emotional changes in his life. His mind is unconsciously seeking out the familiar patterns of the pain.

Dickinson even postulates that House’s initial resistance to the morphine may have been an unconscious acknowledgement of the origins of the spasms. Wilson feels another small stab of guilt about this; it’s another reminder that he should have asked more questions, been more sensitive to House’s refusal of the drug.

The voice file concludes with Dick warning him that House’s recovery from the psychosomatic pain could take a lot of time, and with Wilson’s response:

‘As long as it takes. Whatever it takes.’

Wilson shuts off the recording and stands. He needs to check on House, and administer the antibiotic. Before he leaves the kitchen, he looks again at the timeline he’d constructed, and admits to himself that, while he still feels that much of the blame for this diagnosis lies with him, it’s a relief to let go of some of the guilt.

As he exits the kitchen, he reads over his notes and allows himself to feel the first faint stirrings of hope that they might get through this. He enters the living room and lifts his eyes from the page—and he sees House, sitting on the edge of the couch. House’s face is unreadable, and his eyes—those mirrors that Wilson counts on for House’s truth—his eyes are cold, so cold that a shiver goes through Wilson’s body as the two men regard each other.

CHAPTER TWENTY-SIX: Disbelief

“House.” Wilson stands in shock, staring at the figure on the couch—and House stares back, as a brief, wordless communication passes between the two men who know each other so well.

How much did you hear?

All of it.

“We… uh… obviously, we need to talk,” Wilson manages to choke out.

“No, we don’t,” House states flatly. “All you need to know is that your shrink is right; you have nothing to feel guilty about.”

“I… don’t?” Wilson feels suddenly inarticulate, and curses his inability to form a clear thought.

“He’s right because you’re wrong. You can’t feel guilty over a diagnosis that’s incorrect. We won’t have a diagnosis until after we do the muscle biopsy. Until then, the DDX is over; we won’t be discussing it again until we have the results.” House looks away from Wilson and takes a deep breath, composes his face. When he looks back, and speaks again, the coldness is gone from his eyes, the flatness from his tone.

“So, what’s for breakfast? You were running the damned water in there for so long, I was beginning to think the kitchen was flooding. Tell me you were working on some complicated new pancake recipe; I’m starved!”

“Uh… I’ll see what I can find. Glad you’re feeling better. Let me get your meds, and then I’ll see about breakfast. And then after we eat, we… umm… we can talk then.”

“Yeah, maybe we can discuss the lunch menu!” House says heartily. “I was thinking maybe that weird salad you make, you know, the one without lettuce? Now whoever heard of a salad without lettuce?” House smiles and shakes his head.

Wilson doesn’t know what to do. He’d been prepared for angry disbelief, not for this calm, complete denial. So he decides to just play it House’s way for now, until he can figure out how to bring it up again. “Sure,” he says, with an answering smile. “The lettuce-less salad sounds fine. But first, let me scrounge you up a pancake or two before we start worrying about lunch.”

“Sounds fair,” House says, lifting his legs carefully onto the couch, and grabbing the TV remote. There’s a knock at the door as House begins to flip through the channels.

Cuddy’s eyes widen and she starts to ask a question. Wilson shakes his head at her and mouths ‘later.’ So she sets her purse down and walks over to say good morning to House, while Wilson continues on into the kitchen.

But Wilson turns around and listens—as House obviously intends for him to do—when he hears House whisper a little too loudly, in a conspiratorial tone, “Hey, Cuddy; you can’t leave me alone with him! He thinks I’m crazy.” House accompanies the statement with the universal gesture of insanity; his finger makes an exaggerated circle at the side of his head, as he looks, almost challengingly, at Wilson.

Intuitively, Wilson knows that this is House’s way of telling him that he hasn’t completely rejected the new diagnosis, that it’s up there somewhere in that brilliant mind, just perking around. House had been the one to declare the subject closed, but apparently there’s a clause in the rules; House is to be allowed to joke about it. If that’s what it takes for you to accept the idea, Wilson thinks, I’ll be more than happy to be your fall guy; make all the jokes you want.

So Wilson puts his hands on his hips, shakes his head slowly, and says chidingly, “House, you’re playin’ dirty, ya know.” And he makes absolutely no attempt at all to keep either the humor or the affection out of his voice. He heads off to the kitchen feeling real optimism.

Wilson’s well aware that the worst of the trouble is yet to come—but for the first time since last night, he’s starting to believe that they’ll get through it, with their newly-formed little family intact.

Yeah, I know there’s gonna be fireworks. Big, bad fireworks. But I’m beginning to think that when the explosions are over and the sparks die down, he’s gonna let me be there to catch him. And Cuddy. That woman’ll catch us both; she’s amazing.

Wilson stands in the kitchen a moment, trying to memorize this moment of hope, to fix it firmly in his mind; he knows that he’ll need to recall this feeling during the days and weeks to come, that it’ll help pull him through, so that he can pull House through. Then he takes a deep breath, pours coffee for House and Cuddy, and returns to the living room.

Cuddy’s just finished drawing the blood for morning labs, and is trying, in vain, to conduct a proper assessment. House is giving Cuddy a hard time, and they’re both enjoying every minute of it.

“Interesting theory,” Wilson responds dryly as he sets the coffee tray on the table. “I’ll have to look it up, but I’m pretty certain that the blouse is missing something in the bronchodilation department.”

House leers at Cuddy’s chest. “I assure you, Jimmy, that the blouse is missing absolutely nothing. They’re both there, in all their awesome abundance. And all the heavy breathing is dilating my airways just fine.”

“Good try,” Cuddy responds with a stern look. “But I’m still gonna finish this assessment and get your neb ready. So you’re going to have to train your eyes elsewhere while I go get the nebulizer.”

“That’s okay,” House assures her. “The back view’s almost as good as the front!”

“Incorrigible,” Cuddy mutters as she leaves for the equipment. But she throws him a smile, and a wink, over her shoulder.

House reaches out to grab his coffee mug. “Wait,” Wilson says. “Cuddy get your temp yet?”

“No, but I’m sure she’s caused it to go up a degree or two,” House says as Cuddy reenters. She rolls her eyes at him while Wilson hands him the thermometer.

“That should shut him up for a minute or two,” Wilson says to Cuddy when House has the thermometer in his mouth. But they both wind up laughing, as House demonstrates that the inability to talk has no effect on his ability to be just as suggestively eloquent in the expressions he aims Cuddy’s way.

When the thermometer beeps, House hands it to Wilson and reaches for the coffee. “This is good,” he says, “But actual food would be better.”

“Yeah, I’m working on that,” Wilson says distractedly as he looks at the reading on the thermometer. “Maybe Cuddy did raise your temp. It’s one-oh-one. You feeling all right?”

“Just fine,” House assures him. “Except for the malnutrition that’s setting in. Sick people need food. Quit being a doctor, and go be a chef.”

“I’m going. Pancakes coming up. Just take it easy, okay? Look at something a little less stimulating. Like that pay-per-view cable bill you’ve been ignoring all week. You don’t pay it, porn-on-demand becomes nothing but a dim memory, ya know.” Wilson returns to the kitchen to start breakfast as Cuddy gets the antibiotic running.

A few minutes later, Cuddy joins him in the kitchen. “What happened this morning? How’d he hear the file?”

“Not sure. He mentioned hearing the water running in the kitchen. Said he thought I was cooking. I was cleaning up some coffee. A lot of coffee. Guess I didn’t hear him over the water, and he just sat down to await his breakfast. Or something. At any rate, turns out he heard it, beginning to end. Told me not to feel guilty. Said it wasn’t necessary, since the diagnosis is wrong. And then, he said we wouldn’t have a diagnosis until after the biopsy, and we’d discuss it then. And only then. But I’m beginning to get the feeling that the moratorium on bringing it up applies only to me.” Wilson rolls his eyes; the rules House creates can change as quickly as House’s next whim.

“So what are you gonna do?”

“Play it his way, for now. Something’ll give soon; he’s already making jokes about it. And there’s this,” Wilson looks at Cuddy with happy surprise, as if it’s just occurred to him; “There’s nothing physically wrong with the leg; he’s gonna be okay!”

Cuddy nods at Wilson, tries to give him the smile he expects, but her own happiness is tempered. Doesn’t seem to me that either of them is really dealing with this yet, she thinks. I just hope they can hold it together until Dickinson gets here on Friday.

Cuddy takes the breakfast tray that Wilson hands her, puts a smile on her face, and returns to the living room.

CHAPTER TWENTY-SEVEN: Agonies

After Cuddy leaves for work, Wilson wonders if House’s playful mood will continue, or if Cuddy’s presence was simply a buffer for two friends who find themselves on opposite sides of a diagnosis.

But House continues to behave as if this morning’s conversation had never taken place. While the low-grade fever has him a bit subdued, he still jokes with Wilson about Wilson’s current losing streak in their most recent video poker contest. And he gets in a couple more digs about the new diagnosis, even suggesting that he might have ‘psychosomatic sputum’ in his lungs, thereby causing a ‘conversion cough.’ And Wilson has to laugh, because it’s funny. And because it’s further proof that House continues to examine and consider the diagnosis, which feeds Wilson’s hope of a positive—and peaceful—outcome.

At lunchtime, House eats just enough soup to keep Wilson’s concern about his appetite at bay, and then challenges Wilson to another game of video poker. When it’s clear that Wilson’s losing streak is going to continue uninterrupted, House remarks casually, “Sure hope your luck is better Friday night.”

Of course; he heard us arrange the game on the voice file. Surprised he’s decided to allow Dick’s visit. Probably just wants to ‘prove’ that the diagnosis is wrong, but that’s okay; it’s better than I’d hoped for. I guess I thought he’d just refuse to let Dick come.

“I don’t think it’s gonna matter how good my luck is,” he tells House with a grin. “Dick might even have you beat with his ‘bluff detection’ skills; never could pull anything over on him in college. Reads people the way we read x-rays; analyzes every angle.” Wilson doesn’t miss the dark frown that this statement puts on House’s face, but decides that House just doesn’t like the possibility of losing at poker.

When the game ends, House decides to take a shower. But he looks tired, washed out from the fever. “Why not take a nap first?” Wilson suggests. “Give that temp a chance to go down on its own.”

Wilson decides not to argue; House does seem to be doing all right. He’s been making his trips to the bathroom today using only his cane, hasn’t even requested the wheelchair at all. And all he’s gotta do is get safely to the shower chair; it’s not like there’s major physical exertion involved. Gotta stop worrying so much, start giving him back some control. Even more important now, to reinforce the trust.

Wilson disconnects the TPN, hands House his cane, and even refrains from saying, “Call me if you need me.” He does, however, find plenty of things to do in the vicinity of the bathroom for the next twenty minutes.

When he hears the water shut off, he waits a few more minutes, then starts towards the kitchen—he’d prefer not to be accused of hovering when House comes out. But he’s still close enough to the bathroom to hear the quiet, grudging call through the door, “Wilson….”

Wilson goes back towards the bathroom. “House, you okay?”

The door opens slowly, and Wilson notes immediately how heavily House is leaning on his cane. “Gonna just… go to the bedroom. Take… that nap now. Might… want the chair, though,” House says. He’s trying hard to keep the tone of his voice casual, but Wilson recognizes the strain behind the words, and the pattern of the pauses, and the pull of stress at the corners of his eyes.

“Just stay right there. Won’t take me two seconds to get the wheelchair. I’ll be right back,” he assures House calmly.

As Wilson retrieves the wheelchair from the bedroom, he remembers the disconcerted look on House’s face when he’d mentioned how well Dick could ‘read’ people. If that comment made him work himself into this state, what the hell will happen on Friday? House likes to solve the puzzle; he’s not going to be comfortable with being the puzzle.

Wilson hasn’t had much time to decide how to handle the spasms in light of the new diagnosis. As he goes back to House, he’s trying to figure out how much help House will accept, how much help he should offer.

House is gripping the doorframe with his free hand; the other is clenched around the handle of the cane, and the cane itself is trembling. So Wilson takes both of House’s elbows in a firm, reassuring hold, and then lowers House carefully into the wheelchair, and moves quickly to the bedroom. He’s thankful that he’s able to transfer House to the bed before the spasm builds any more.

“Gonna nap now,” House’s voice is rough; he’s using all his energy to try to sound as if nothing’s wrong. “Shut the door on your way out, will ya?”

“Fat chance, buddy.” Wilson almost whispers the words as he sits down on the edge of the bed next to House.

House’s eyes close tightly. He’s got both hands balled into tight fists at his sides to keep them from going to the muscle, and the beads of sweat on his forehead have nothing to do with fever. When he speaks, the word is pulled from him in anguished desperation. “Please.”

Wilson knows how much that one word cost him, and the heaviness in his own chest makes speaking difficult. But he says the words in a firm, measured tone. “Nope. I’m staying, pal, and the deal’s the same. Medical help, or the support of a friend, or both. Up to you.”

House opens his eyes to look up at Wilson. He can actually feel the compassion radiating from the empathetic brown eyes. House reminds himself that things are different now, that feeling cared-for doesn’t suck, and in that moment, his resolve to hide the pain breaks. “Both, Jimmy… both.”

Wilson’s glad that he’d thought to pre-draw several 5mg syringes; he doesn’t want to leave House’s side right now, there’s too much at stake. He retrieves the medication and a flush from the drug box, and sits back down at House’s side to administer it.

Neither man speaks while Wilson pushes the med. House’s eyes are closed; he’s concentrating on breathing his way through it. And Wilson knows that no words will bring reassurance this time; he maintains a warm, respectful silence, offering comfort with the touch of his free hand on House’s arm. Wilson finishes with the flush, sets the syringes down, and reaches for a pulse. He’s surprised when House opens his eyes and clasps his fingers around Wilson’s wrist.

“Why?” House asks, looking directly at him.

“Why what?” Wilson responds—but he thinks he knows what the question is, and he’s afraid he doesn’t have an answer for it.

“For years, you told me the pain was all in my head. You said I was just an addict. You wanted me to see a shrink. Now, you think you’ve had your diagnosis confirmed. Yet here you are. Treating my pain. Why now?” Although the spasm is ebbing, House’s voice remains strained; this question—and Wilson’s response—are important to him.

And as the last words leave House’s lips, Wilson knows the answer. “For years, I watched what you were going through. That’s all I did; I watched you suffer. Guess I… didn’t wanna think about it too much. Twelve days ago, when you collapsed, I opened my eyes, for the first time, and….” He pauses, not quite trusting himself to go on.

Wilson bows his head, rubs a hand across his face, tries to compose himself before he speaks again. It’s only a few words, but they’re the most honest, most heart-wrenching words he’ll ever speak. And the most difficult. So he takes a deep breath, and tells himself that he owes this truth to House. But still, the next four painful words come out as two separate, broken sentences.

“I saw. You suffer.”

And House understands. He knows that inside those four ragged words, choked out over a swallowed sob, are all the honesty that Wilson can offer, and the regret for what House has been through, and the guilt that Wilson’s been dealing with.

House acknowledges Wilson’s words with a brief squeeze of the wrist he still holds, and an oddly apologetic look in his eyes. Then he says, hesitantly, “It’s real, you know. The pain.”

Wilson doesn’t even have to think about the answer to that. His voice is strong again as he answers, “I know. Whatever the cause, the pain is real. And it will be treated.”

“Glad we’re on the same page there, anyway,” House says, and although his voice is weak, he tries for a sardonic tone—he still wants Wilson to know that he disagrees with the diagnosis. So Wilson nods, acknowledging it.

But Wilson hears the relief behind the words; House knows that his pain’s being taken seriously. And now that this hurdle’s been crossed, and the tension has ebbed, he sees that the morphine and the relief are conspiring to lull House to sleep. But House is fighting it. He’s still watching Wilson; he almost seems to be awaiting his permission to give in to it. So Wilson says brusquely, “Catch that nap now; you’re a handful, ya know, and I could use the break.”

House smiles faintly, and closes his eyes. And all Wilson has the energy to do is shake his head in fond exasperation, and silently leave the room.

His mind is unconsciously seeking out the familiar patterns of the pain.

Hey, I wasn't too far off! And yes, I can relate to that- when a bad pain suddenly disappears my first unconscious reaction isn't "yay, it gone" it's "where did it go and where will it show up next"- the body may technically be done with the pain but the mind isn't about to let go of what its been fighting against. Going to be interesting to see how House comes to terms with the fact physically he's fine but mentally he still has a way to go in coping with this, though I would think having Wilson admit that he now knows the pain itself is real might make it easier. But I'm sure they are going to go through the wringer.

right again (about the wringer part)! and yes, i can relate to every damned thing you said about yourself, and pain. people who've never suffered chronic pain, however, look at us like we must have the most negative mindset in the world... sigh. ;)

I think that may be why people might have misread the clues though- they want a physical reason for House to be in that much pain- and if you haven't had to deal with the mental part of dealing with that kind of pain you might dismiss that possibility- like, to a certain degree Wilson did. I'm thinking Wilson's mindset is probably a lot like the readers- it does take him a while to accept the mental aspect of House's pain and yet it's not until it is set in print that he fully accepts it.

Even though I don't understand chronic pain, I do understand the mental issues that are being presented in this story, and although House is getting a lot of help and things are slowing fixing themselves in his mind I find myself more worried for Wilson just because a lot of his issues come from how House is doing.

yes; poor wilson always seems to have to be the 'sacrificial lamb' for house's various issues. but i do think wilson may be a bit stronger mentally and emotionally than we sometimes give him credit for--else he'd not have lasted this long as house's friend!